Headaches are quite common. Within a given year 90-95% of individuals will have at least one headache. There are basically 2 types of headaches: Primary and secondary. Primary headaches includes tension headaches, migraine headaches and cluster headaches. These are the most common, accounting for at least 95% of headaches. Secondary headaches are headaches due to problems such as diseases of the brain, infections, circulation problems and disorders of the eye, ear and nose. Somewhere in between these 2 major categories may be headaches related to disorders of the neck portion of the spine. However, how frequent these so-called “cervicogenic headaches” are is uncertain. The basis of the uncertainty is that they are difficult to diagnose and there is a lack of well-defined diagnostic criteria. The manifestations of cervogenic headaches may overlap with migraine and tension headaches and they may also occur in combination..

The possible sources of cervicogenic headaches include structures in the neck which have a rich supply of nerve input. These structures include the facet (zygapophyseal) joint, the intervertebral discs as well as ligaments and muscles of the neck. It is often theorized that the most important structural basis for cervicogenic headaches may be the facet joints. These joints have been demonstrated to be the single most common source of pain after neck whiplash injuries. This has been determined by tenderness on examination and manipulation as well as diagnostic tests consisting of local anesthetic blocks to the joints. The connection of headaches and painful structures of the neck is probably related to the overlap of the nerves which sends signals to the brain from both the back of the head and the neck region. The nerve cells of the trigeminal nucleus extend from the brainstem to the upper neck area and relay sensory information about the face and head. In extending down to the neck portion of the spinal cord, there is overlap with the sensory nerve centers of the upper 3 or 4 cervical (neck) spinal cord segments.

Treatment for these headaches is directed to the area thought to be the likely pain source. For some, this may be excessive muscle tension or irritation of the fascia investing the muscle tissue. For those instances modalities such as physical therapy, acupuncture , biofeedback , low level laser therapy and massage therapy may be useful. For others the basis could be injury or degeneration of the facet joints which could respond to selective anaesthetic nerve blocks. Recent observations show promising results with the use of nerve stimulators to stimulate the occipital nerve at the back of the head for relief of some types of headaches and upper neck pain. This is will be the topic of another post in the future.

Neurologists see a much higher percentage of patients with headaches than neurosurgeons. Headaches are very common and most people with chronic headaches do not require neurosurgical evaluation. Of the entire population of patients with headaches seen by neurologists, a relatively small proportion of those patients will have structural abnormalities that can be imaged on a brain CT or MRI scan. These individuals with structural abnormalities would be more apt to be referred to a neurosurgeon. Of those without structural problems, most of them will be treated with medications. An interesting question is , of those not responding to medications, how many would benefit from techniques such as cervical spine nerve blocks or neuromodulation with spinal cord stimulators as I have previously mentioned. I am uncertain of the answer but it requires being open to looking at different possibilities.

Dr Bernard,
I have to say, that I have now had two different surgeries performed by you over the last four years. Both of which turned out phenomenally ~ I use to have headaches (which included migraines) every day~ Since the surgery on my neck, my headaches have subsided at least by 80%. The time I spent in the hospital was only an over night stay and that was due to the surgery calendar only~I have since healed and no one can even see the scar~
My other experience was with my back; I have had issues with it for over 30 years. I was in constant pain throughout my lower back and it would radiate down into my legs… It has been only 9 weeks since my back surgery and I have been back at work for three weeks. I spent only a couple hours in the hospital following recovery.
Dr Bernard, in my opinion, I would not pick a different surgeon to do any further surgery if needed…(hoping that there will be none of course)..
You really are very easy to speak with and you talk to people in a manner in which is easily understood. You are very polite and took the time to answer all of my questions and concerns
Thank you a millions times over…

what about patients like myself who have been told they have iih because my first lumbar puncture was 55cm h2o yet i continue to get headaches and its not being looked into even though ive had a 2nd LP that was within normal range and a manometry that was normal.

I am not able to comment on the specifics of your case, not having the details of a history and physical examination. However, idiopathic intracranial hypertension(IIH) or pseudotumor cerebri is characterized by high pressure in the brain of uncertain origin. It has been associated with certain medications but the cause remains elusive. It is not related to the cervicogenic headaches that can be observed with degenerative changes of the upper cervical spine.
The cause of headaches is varied. An exhaustive evaluation could include detailed history, physical examination and various diagnostic tests. Sometimes even after all of that, a label may be given but the exact cause may not be known.

Hi, I have headaches night and early morning, pulsating pounding in head, sour to touch, swelling eyes and face. Not sure what’s going on,but not sleeping well, I already use a breathing machine due to stopping breathing in middle of night many times , and sleep elevated some. Need sleep help!!!

Your description suggests that you may be under treatment for sleep apnea which is a potential cause of headaches. However, it is cause that is not related to headaches due to problems at the cervical spine level.